Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high-risk for hepatocellular carcinoma
Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high-risk for hepatocellular carcinoma
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DOI：
10.1002/cncr.22242
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发表时间：
2006-11-01
期刊：
影响因子：
6.2
通讯作者：
Changchien, Chi-Sin
中科院分区：
文献类型：
--
作者：
Lu, Sheng-Nan;Wang, Jing-Houng;Changchien, Chi-Sin
背景本研究的目的是探讨血小板计数在肝硬化诊断中的作用，以及在社区肝细胞癌（HCC）筛查项目中识别高危个体的作用。初步研究1确定了慢性B型肝炎病毒（HBV）感染（n = 122例患者）和丙型肝炎病毒（HCV）感染（n = 244例患者）患者中血小板计数与病理性肝纤维化评分之间的相关性。初步研究2调查了HCC患者（n = 4042例患者）中血小板减少（< 150 x 10（3）/mm（3））的个体比例。初步研究3证明了抗-HCV阳性个体（n = 75例患者）中血小板计数和超声（US）实质评分之间的相关性。核心研究是在抗-HCV高患病率的乡镇（n = 4616人）和抗-HCV低患病率的乡镇（n = 1694人）中，对40岁或以上的居民进行2阶段、以社区为基础的HCC筛查。血小板减少的患者进行超声和甲胎蛋白筛查。在抗-HCV阳性的个体中，血小板计数根据病理性纤维化评分或肝实质疾病的US评分的增加而降低：诊断肝硬化的最佳临界血小板计数为150 × 10 3/mm 3。病理性肝硬化的敏感性和特异性分别为68.2%和76.4%，超声肝硬化的敏感性和特异性分别为76.2%和87.8%。48%的HCC患者是血小板减少性的。HCV相关HCC患者血小板减少的比例（63%）显著高于HBV相关HCC患者（42%）。在抗-HCV高、低流行区，血小板减少的患病率分别为17.9%和6.1%（P <0.001）。25例患者被诊断为HCC，所有这些患者都居住在高发乡镇。血小板减少症是肝硬化的有效替代物，也是识别HCC高危个体的有效标志物，尤其是在HCV高发地区。
BACKGROUND. The objective of this study was to examine the usefulness of platelet counts in the diagnosis of cirrhosis and for identifying high-risk individuals in a community-based hepatocellular carcinoma (HCC) screening program.METHODS. Pilot Study 1 determined the correlation between platelet counts and pathologic hepatic fibrosis scores among individuals with chronic hepatitis B virus (HBV) infection (n = 122 patients) and hepatitis C virus (HCV) infection (n = 244 patients). Pilot Study 2 investigated proportions of individuals with thrombocytopenia (< 150 x 10(3)/mm(3)) among patients with HCC (n = 4042 patients). Pilot Study 3 demonstrated the correlation between platelet counts and ultrasonographic (US) parenchyma scores among anti-HCV-positive individuals (n = 75 patients). The core study was a 2-stage, community-based screening for HCC among residents age 40 years or older in townships with a high prevalence of anti-HCV (n = 4616 individuals) and in townships with a low prevalence of anti-HCV (n = 1694 individuals). Patients with thrombocytopenia were identified for US and alpha-fetoprotein screening.RESULTS. Among the individuals who were positive for anti-HCV, platelet counts decreased according to increased pathologic fibrosis scores or US scores for liver parenchyma disease: The best cutoff platelet count was 150 x 10(3)/mm(3) for a diagnosis of cirrhosis. The sensitivity and specificity were 68.2% and 76.4%, respectively, for pathologic cirrhosis and 76.2% and 87.8%, respectively, for US cirrhosis. Forty-eight percent of patients with HCC were thrombocytopenic. The proportion of thrombocytopenia was significantly greater in patients with HCV-related HCC (63%) than in patients with HBV-related HCC (42%). In the townships with high and low anti-HCV prevalence, the prevalence of thrombocytopenia was 17.9% and 6.1%, respectively, (P < .001), respectively. Twenty-five patients were diagnosed with HCC, and all of those patients resided in the high-prevalence township.CONCLUSIONS. Thrombocytopenia was a valid surrogate of cirrhosis and a valid marker for the identification of individuals at high-risk for HCC, especially in areas that had a high prevalence of HCV.